|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$568.40 |
| Rate for Payer: BCBS Complete |
$324.80
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.40
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$706.30 |
| Rate for Payer: BCBS Complete |
$403.60
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$927.17 |
| Rate for Payer: Aetna Commercial |
$54.50
|
| Rate for Payer: Aetna Medicare |
$42.30
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$40.67
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$58.56
|
| Rate for Payer: Cofinity Commercial |
$54.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.67
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.70
|
| Rate for Payer: PACE SWMI |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$40.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.46
|
| Rate for Payer: Priority Health Medicare |
$40.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.67
|
| Rate for Payer: UHC Medicare Advantage |
$41.89
|
|
|
PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 53661
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$2,149.12 |
| Rate for Payer: Aetna Commercial |
$53.31
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$39.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.12
|
| Rate for Payer: BCN Commercial |
$108.48
|
| Rate for Payer: BCN Medicare Advantage |
$39.78
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Commercial |
$53.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.78
|
| Rate for Payer: Mclaren Medicaid |
$25.56
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.77
|
| Rate for Payer: PACE SWMI |
$39.78
|
| Rate for Payer: PHP Medicare Advantage |
$39.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.84
|
| Rate for Payer: Priority Health Medicare |
$39.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.78
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
|
|
PR DILATION CERVICAL CANAL INSTRUMENTAL SPX
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 57800
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,422.71 |
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: Aetna Medicare |
$48.70
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$46.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$114.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.83
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$62.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.83
|
| Rate for Payer: Mclaren Medicaid |
$30.89
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.17
|
| Rate for Payer: PACE SWMI |
$46.83
|
| Rate for Payer: PHP Medicare Advantage |
$46.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.23
|
| Rate for Payer: Priority Health Medicare |
$46.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.23
|
|
|
PR DILATION & CURETTAGE CERVICAL STUMP
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 57558
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,924.60 |
| Rate for Payer: Aetna Commercial |
$169.48
|
| Rate for Payer: Aetna Medicare |
$131.54
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$126.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.60
|
| Rate for Payer: BCN Commercial |
$233.59
|
| Rate for Payer: BCN Medicare Advantage |
$126.48
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$182.13
|
| Rate for Payer: Cofinity Commercial |
$169.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.48
|
| Rate for Payer: Mclaren Medicaid |
$83.28
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.80
|
| Rate for Payer: PACE SWMI |
$126.48
|
| Rate for Payer: PHP Medicare Advantage |
$126.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.69
|
| Rate for Payer: Priority Health Medicare |
$126.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.48
|
| Rate for Payer: UHC Medicare Advantage |
$130.27
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$515.37 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Aetna Commercial |
$718.25
|
| Rate for Payer: BCBS Trust/PPO |
$653.02
|
| Rate for Payer: BCN Commercial |
$653.02
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$726.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.00
|
| Rate for Payer: Healthscope Commercial |
$760.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$633.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.25
|
| Rate for Payer: PHP Commercial |
$718.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.60
|
| Rate for Payer: UHC Core |
$705.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.75
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$200.69 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: Aetna Commercial |
$718.25
|
| Rate for Payer: Aetna Medicare |
$219.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.06
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$211.25
|
| Rate for Payer: BCBS Trust/PPO |
$656.99
|
| Rate for Payer: BCN Commercial |
$656.99
|
| Rate for Payer: BCN Medicare Advantage |
$211.25
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$726.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.25
|
| Rate for Payer: Healthscope Commercial |
$760.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$633.75
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$221.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.25
|
| Rate for Payer: PACE Senior Care Partners |
$200.69
|
| Rate for Payer: PACE SWMI |
$211.25
|
| Rate for Payer: PHP Commercial |
$718.25
|
| Rate for Payer: PHP Medicare Advantage |
$211.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.15
|
| Rate for Payer: Priority Health Medicare |
$211.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.37
|
| Rate for Payer: Railroad Medicare Medicare |
$211.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.60
|
| Rate for Payer: UHC Core |
$705.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.25
|
| Rate for Payer: UHC Medicare Advantage |
$217.59
|
| Rate for Payer: VA VA |
$211.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$633.75
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
58120
|
| Min. Negotiated Rate |
$150.38 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Mclaren Medicaid |
$150.38
|
| Rate for Payer: Meridian Medicaid |
$157.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.87
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$237.45
|
|
|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$150.38 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$308.91
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: BCBS Complete |
$157.90
|
| Rate for Payer: BCBS MAPPO |
$230.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$438.83
|
| Rate for Payer: BCN Medicare Advantage |
$230.53
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$308.91
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.53
|
| Rate for Payer: Mclaren Medicaid |
$150.38
|
| Rate for Payer: Meridian Medicaid |
$157.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.06
|
| Rate for Payer: PACE SWMI |
$230.53
|
| Rate for Payer: PHP Medicare Advantage |
$230.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.87
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.53
|
| Rate for Payer: UHC Medicare Advantage |
$237.45
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$112.61
|
| Rate for Payer: Aetna Medicare |
$87.40
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS MAPPO |
$84.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.34
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$84.04
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$121.02
|
| Rate for Payer: Cofinity Commercial |
$112.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.04
|
| Rate for Payer: Mclaren Medicaid |
$54.95
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.24
|
| Rate for Payer: PACE SWMI |
$84.04
|
| Rate for Payer: PHP Medicare Advantage |
$84.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.93
|
| Rate for Payer: Priority Health Medicare |
$84.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.04
|
| Rate for Payer: UHC Medicare Advantage |
$86.56
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.08
|
| Rate for Payer: Aetna Medicare |
$80.78
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$77.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: BCN Medicare Advantage |
$77.67
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Cofinity Commercial |
$104.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.67
|
| Rate for Payer: Mclaren Medicaid |
$50.48
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.55
|
| Rate for Payer: PACE SWMI |
$77.67
|
| Rate for Payer: PHP Medicare Advantage |
$77.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.76
|
| Rate for Payer: Priority Health Medicare |
$77.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.67
|
| Rate for Payer: UHC Medicare Advantage |
$80.00
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$624.38 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: Aetna Medicare |
$83.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.62
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$80.50
|
| Rate for Payer: BCBS Trust/PPO |
$250.36
|
| Rate for Payer: BCN Commercial |
$250.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.50
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.50
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PACE Senior Care Partners |
$76.48
|
| Rate for Payer: PACE SWMI |
$80.50
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: PHP Medicare Advantage |
$80.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.14
|
| Rate for Payer: Priority Health Medicare |
$80.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.39
|
| Rate for Payer: Railroad Medicare Medicare |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.36
|
| Rate for Payer: UHC Core |
$268.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.50
|
| Rate for Payer: UHC Medicare Advantage |
$82.92
|
| Rate for Payer: VA VA |
$80.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.50
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
43450
|
| Min. Negotiated Rate |
$196.39 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: BCBS Trust/PPO |
$248.84
|
| Rate for Payer: BCN Commercial |
$248.84
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.36
|
| Rate for Payer: UHC Core |
$268.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.50
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$104.08
|
| Rate for Payer: Aetna Medicare |
$80.78
|
| Rate for Payer: BCBS Complete |
$53.00
|
| Rate for Payer: BCBS MAPPO |
$77.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$275.61
|
| Rate for Payer: BCN Medicare Advantage |
$77.67
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Cofinity Commercial |
$104.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.67
|
| Rate for Payer: Mclaren Medicaid |
$50.48
|
| Rate for Payer: Meridian Medicaid |
$53.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.55
|
| Rate for Payer: PACE SWMI |
$77.67
|
| Rate for Payer: PHP Medicare Advantage |
$77.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.76
|
| Rate for Payer: Priority Health Medicare |
$77.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.67
|
| Rate for Payer: UHC Medicare Advantage |
$80.00
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$100.00
|
| Rate for Payer: Aetna Medicare |
$77.62
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$74.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$112.30
|
| Rate for Payer: BCN Medicare Advantage |
$74.63
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.63
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.36
|
| Rate for Payer: PACE SWMI |
$74.63
|
| Rate for Payer: PHP Medicare Advantage |
$74.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.41
|
| Rate for Payer: Priority Health Medicare |
$74.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.63
|
| Rate for Payer: UHC Medicare Advantage |
$76.87
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$619.17 |
| Rate for Payer: Aetna Commercial |
$76.74
|
| Rate for Payer: Aetna Medicare |
$59.56
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS MAPPO |
$57.27
|
| Rate for Payer: BCBS Trust/PPO |
$619.17
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$57.27
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Cofinity Commercial |
$82.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.27
|
| Rate for Payer: Mclaren Medicaid |
$37.91
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.13
|
| Rate for Payer: PACE SWMI |
$57.27
|
| Rate for Payer: PHP Medicare Advantage |
$57.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.48
|
| Rate for Payer: Priority Health Medicare |
$57.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.27
|
| Rate for Payer: UHC Medicare Advantage |
$58.99
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$171.63
|
| Rate for Payer: Aetna Medicare |
$133.20
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$128.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$188.63
|
| Rate for Payer: BCN Medicare Advantage |
$128.08
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cofinity Commercial |
$184.44
|
| Rate for Payer: Cofinity Commercial |
$171.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.08
|
| Rate for Payer: Mclaren Medicaid |
$83.28
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.48
|
| Rate for Payer: PACE SWMI |
$128.08
|
| Rate for Payer: PHP Medicare Advantage |
$128.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.74
|
| Rate for Payer: Priority Health Medicare |
$128.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.08
|
| Rate for Payer: UHC Medicare Advantage |
$131.92
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$1,149.58 |
| Rate for Payer: Aetna Commercial |
$253.88
|
| Rate for Payer: Aetna Medicare |
$197.04
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS MAPPO |
$189.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.58
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$189.46
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cofinity Commercial |
$272.82
|
| Rate for Payer: Cofinity Commercial |
$253.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.46
|
| Rate for Payer: Mclaren Medicaid |
$123.97
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.93
|
| Rate for Payer: PACE SWMI |
$189.46
|
| Rate for Payer: PHP Medicare Advantage |
$189.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$905.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.26
|
| Rate for Payer: Priority Health Medicare |
$189.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.46
|
| Rate for Payer: UHC Medicare Advantage |
$195.14
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$549.43 |
| Rate for Payer: Aetna Commercial |
$84.35
|
| Rate for Payer: Aetna Medicare |
$65.47
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS MAPPO |
$62.95
|
| Rate for Payer: BCBS Trust/PPO |
$549.43
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.95
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$90.65
|
| Rate for Payer: Cofinity Commercial |
$84.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.95
|
| Rate for Payer: Mclaren Medicaid |
$40.04
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.10
|
| Rate for Payer: PACE SWMI |
$62.95
|
| Rate for Payer: PHP Medicare Advantage |
$62.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.13
|
| Rate for Payer: Priority Health Medicare |
$62.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.95
|
| Rate for Payer: UHC Medicare Advantage |
$64.84
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$244.07 |
| Rate for Payer: Aetna Commercial |
$69.80
|
| Rate for Payer: Aetna Medicare |
$54.17
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS MAPPO |
$52.09
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$124.13
|
| Rate for Payer: BCN Medicare Advantage |
$52.09
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$75.01
|
| Rate for Payer: Cofinity Commercial |
$69.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.09
|
| Rate for Payer: Mclaren Medicaid |
$33.65
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.69
|
| Rate for Payer: PACE SWMI |
$52.09
|
| Rate for Payer: PHP Medicare Advantage |
$52.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.83
|
| Rate for Payer: Priority Health Medicare |
$52.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.09
|
| Rate for Payer: UHC Medicare Advantage |
$53.65
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$1,543.16 |
| Rate for Payer: Aetna Commercial |
$113.46
|
| Rate for Payer: Aetna Medicare |
$88.06
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS MAPPO |
$84.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$248.73
|
| Rate for Payer: BCN Medicare Advantage |
$84.67
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$121.92
|
| Rate for Payer: Cofinity Commercial |
$113.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.67
|
| Rate for Payer: Mclaren Medicaid |
$54.95
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.90
|
| Rate for Payer: PACE SWMI |
$84.67
|
| Rate for Payer: PHP Medicare Advantage |
$84.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.79
|
| Rate for Payer: Priority Health Medicare |
$84.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.67
|
| Rate for Payer: UHC Medicare Advantage |
$87.21
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Medicare |
$72.97
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS MAPPO |
$70.16
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$237.98
|
| Rate for Payer: BCN Medicare Advantage |
$70.16
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$101.03
|
| Rate for Payer: Cofinity Commercial |
$94.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.16
|
| Rate for Payer: Mclaren Medicaid |
$45.37
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.67
|
| Rate for Payer: PACE SWMI |
$70.16
|
| Rate for Payer: PHP Medicare Advantage |
$70.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.01
|
| Rate for Payer: Priority Health Medicare |
$70.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.16
|
| Rate for Payer: UHC Medicare Advantage |
$72.26
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,411.09 |
| Rate for Payer: Aetna Commercial |
$84.63
|
| Rate for Payer: Aetna Medicare |
$65.69
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$63.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.09
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: BCN Medicare Advantage |
$63.16
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$90.95
|
| Rate for Payer: Cofinity Commercial |
$84.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.16
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.32
|
| Rate for Payer: PACE SWMI |
$63.16
|
| Rate for Payer: PHP Medicare Advantage |
$63.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.13
|
| Rate for Payer: Priority Health Medicare |
$63.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.16
|
| Rate for Payer: UHC Medicare Advantage |
$65.05
|
|
|
PR DIPHENHYDRAMINE HCL INJECTIO
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1200
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
|
